Title: 4-H After-school Program Youth Progress Report
End of Semester Evaluation
Contact who has experience using this assessment instrument:
created for the 4-H Urban Outreach Program by Emily Robin Solomon
7/97 & adapted by Suki Tabor 12/97
Student's Name:
# of After-school days attended: out of total days:
After-school Group:
Age:
Please consider the following list of ASSETS & rate this student's
level at this point in the year.
AFTER-SCHOOL ACTIVITIES & EXPERIENCE
Homework Program
Student is interested & involved in homework.
(low) 1 2 3 4 5 (high)
Arts & Crafts
Student is interested & involved in arts & crafts activities.
(low) 1 2 3 4 5 (high)
Sports & Recreation
Student is interested & involved in sports & games.
(low) 1 2 3 4 5 (high)
Literacy Program
Student is interested & involved in reading & writing
activities.
(low) 1 2 3 4 5 (high)
All other After-school Activities
Student is enthusiastic about overall After-school experience.
(low) 1 2 3 4 5 (high)
SOCIAL COMPETENCY
Interpersonal Skills
Student has sensitivity, compassion & friendship skills.
(low) 1 2 3 4 5 (high)
Self Esteem
Student demonstrates a high level of self respect & self esteem.
(low) 1 2 3 4 5 (high)
Resistance Skills
Student can resist negative peer pressure.
(low) 1 2 3 4 5 (high)
Conflict Resolution
Student tries to resolve conflicts in a non-violent way.
(low) 1 2 3 4 5 (high)
Planning & decision making
Student has ability to plan ahead & make positive choices.
(low) 1 2 3 4 5 (high)
Leadership
Student demonstrates positive leadership skills.
(low) 1 2 3 4 5 (high)
Communication
Student has ability to listen & communicate with peers &
counselors.
(low) 1 2 3 4 5 (high)
LIFE SKILLS & VALUES
Responsibility
Student is able to take care of self (is punctual, participates
in activities independently, etc.)
(low) 1 2 3 4 5 (high)
Cultural Understanding/Acceptance
Student is knowledgeable & comfortable with diverse people.
(low) 1 2 3 4 5 (high)
Caring
Student is interested in helping other students and counselors.
(low) 1 2 3 4 5 (high)
Honesty
Student is honest and tells the truth.
(low) 1 2 3 4 5 (high)
What are some of the changes that have occurred for this student
so far?
What are the areas for this student to work on in the future?
Additional Comments:
Counselors Signature
Program Staff Signature
Date
Evaluation Tools Page
ENTRY DATE:: May 1998